Editing Neuroleptic malignant syndrome (section)

==Signs and symptoms==
NMS symptoms include:<ref name=Simon2022>{{cite book | vauthors = Simon LV, Hashmi MF, Callahan AL | chapter = Neuroleptic Malignant Syndrome. | date = August 2022 | title = StatPearls [Internet]. | location = Treasure Island (FL) | publisher = StatPearls Publishing | pmid = 29489248 | url = https://www.ncbi.nlm.nih.gov/books/NBK482282/ }}
</ref>
* [[Hyperpyrexia|Increased body temperature]] >38&nbsp;°C (>100.4&nbsp;°F)
* [[Delirium|Confused]] or [[altered state of consciousness|altered consciousness]]<ref name=Papadakis2023/>
* [[Hyperhidrosis|Excessive sweating]]<ref name=Papadakis2023>{{cite book | chapter = Neuroleptic malignant syndrome. | vauthors = Papadakis MA, McPhee SJ | date = 2023 | title = Quick Medical Diagnosis & Treatment | publisher = McGraw Hill | url = https://accessmedicine.mhmedical.com/content.aspx?bookid=3241&sectionid=271755113 }}</ref>
* Severely rigid muscles<ref name=Simon2022/>
* [[Dysautonomia|Autonomic imbalance]]<ref name=Simon2022/>

The first symptoms of neuroleptic malignant syndrome are usually [[muscle cramp]]s and [[tremor]]s, [[fever]], symptoms of [[autonomic nervous system]] instability such as unstable [[blood pressure]], and sudden changes in mental status (agitation, [[delirium]], or [[coma]]). Other possible symptoms include sweating, [[Dysphagia|trouble swallowing]], tremors, [[urinary incontinence|incontinence]], and [[muteness|mutism]]. Once symptoms appear, they may progress rapidly and reach peak intensity in as little as three days.<ref name=Simon2022/> These symptoms can last anywhere from eight hours to forty days, with the median duration of symptoms, with treatment, being nine days.<ref name=Str2007/><ref name="Wijdicks 2024">{{cite journal |last1=Wijdicks |first1=Eelco F.M. |last2=Ropper |first2=Allan H. |title=Neuroleptic Malignant Syndrome |journal=New England Journal of Medicine |date=26 September 2024 |volume=391 |issue=12 |pages=1130–1138 |doi=10.1056/NEJMra2404606|pmid=39321364 }}</ref> The median onset of symptoms is four days after initiating the offending medication, but in some cases symptoms may begin up to 30 days later.<ref name="Wijdicks 2024" />

Symptoms are sometimes misinterpreted by doctors as symptoms of mental illness which can result in delayed treatment.<ref>{{cite web | vauthors = Milbouer S | title = Quest for the truth | work = Nashua Telegraph | url = http://www.nashuatelegraph.com/apps/pbcs.dll/article?AID=/20050424/NEWS01/104240081 | archive-url = https://web.archive.org/web/20070927222612/http://www.nashuatelegraph.com/apps/pbcs.dll/article?AID=%2F20050424%2FNEWS01%2F104240081 |archive-date=2007-09-27 }}</ref> Symptoms may also be mistaken for similarly presenting conditions such as [[malignant hyperthermia]], [[serotonin syndrome]], or withdrawal from illicit drugs such as [[Alcohol (drug)|alcohol]], [[cocaine]], or [[MDMA]].<ref name="Wijdicks 2024" />

Neuroleptic malignant syndrome (NMS) usually presents with a "lead pipe rigidity" in which the muscles are stiffened and resistance is observed throughout the range of motion on testing. Severe cases may present as [[catatonia]] in which the person is not responsive to stimuli.<ref name="Wijdicks 2024" />

The [[deep tendon reflexes]] in NMS are usually preserved whereas serotonin syndrome presents with [[myoclonus]] or [[hyperreflexia|hyperactive muscle reflexes]].<ref name="Wijdicks 2024" />